Echocardiography in diagnosing and managing aortic valve endocarditis.

During a 36-month period, 14 patients were admitted with endocarditis of the native aortic valve. Echocardiography made a specific contribution to the diagnosis and/or therapeutic management in ten of the 14 (71%). Thirteen patients had aortic valve replacement because of congestive heart failure; only two were stable enough to complete antibiotic therapy prior to operation. There were 12 survivors, all of them alive and clinically improved at nine to 44 months (mean 27 months) of follow-up. There were no instances of recurrent endocarditis. The only medically treated patient died suddenly during the third week of antibiotic therapy. Ten of 14 patients were identified as having valvular vegetations by M-mode or two-dimensional sector echocardiography. Surgical or necropsy corroboration revealed 100% specificity (no false-positive results) and 71% sensitivity of this echocardiographic finding. Aortic valve endocarditis appears to be primarily a surgical disease in which echocardiography plays an important role.